Consequences of Not Getting INR Checked

[KAJ]

About three years ago, my wife befriended an immigrant couple with 18 month old triplets. At the time she was a home health care nurse assigned to the husband after he his AV was replaced. This past Thursday, we received a call he was being admitted to the hospital for a suspected heart attack. A stress was performed on Friday. It was determined he had another heart attack during the stress test. A heart cath was performed yesterday afternoon. It was determined his arteries were not blocked by cholesterol but by several blood clots.

We then learned he and wife cannot remember the last time his PTINR was checked. The last time they went to get it checked, they waited over three hours at their PCP. The doctor finally came out and told them that she had to leave and therefore would not perform the PTINR. They were so disgusted, that they never went back. The couple has not been able to find a different doctor who takes Medicaid.

My wife told his wife to get ask for a social worker while her husband is still in the hospital. Hopefully the social worker can be of some assistance to this family in trying to find a doctor. His poor wife works two jobs while trying to care for the triplets. Unfortunately, this can be a classic example of what can happen when PTINR is not checked regularly.

Karl

 

[catwoman]

Unfortunately, this can be a classic example of what can happen when PTINR is not checked regularly.

I would tend to agree. HOWEVER .....
http://www.valvereplacement.com/forums/showthread.php?t=10820&highlight=valve+warfarin

 

[dick0236]

Unfortunately, this can be a classic example of what can happen when PTINR is not checked regularly.

Karl

I have had only one stroke(at age 38)....but it caused a lifelong problem as I am permanently 50% blind. It was probably caused by going without Coumadin for several days while on a fishing trip. That was 35 years ago, and it taught me, the hard way, that you do not "screw" around with warfarin. Since then, I probably have not missed a dose...well, maybe one or two, in 35 years, and I have routinely checked my INR. Doing what this man did is like grabbing a rattlesnake in the middle of his body....sooner or later, he will BITE you.

My experience with warfarin is that it is a predicable drug. Take it as prescribed and test regularly and it causes few problems. Don't take it and its like playing "Russian Roulette" with three bullets in the chamber...you may get away with it for a short while, but.........

You may have gotten the idea that I am on a "soapbox" about this subject...and you are right. That life altering stroke has been the ONLY problem I have had since my surgery....and the sad thing is that it never should have happened.

 

[hensylee]

that's awful that they couldn't get health care when it's so necessary for life.

 

[geebee]

I am sorry that anyone had to go through this but sometimes health care is inconvenient. There have been times in my life that I waited a couple hours for the doctor only to be told he was called away on an emergency and needed to reschedule. Guess what - I rescheduled. You cannot be discouraged by anything that affects your life. This man did have access to health care but something happened to throw a wrench into the works. Clots can be the price of ignoring the requirements.

This is certainly a good example of why we need our INR checked. This could have been avoided had the patient simply returned to the doctor.

 

[pamela]

Does this test need to be administered by a doc? I know the levels should be monitored and watched, but wouldn't a lab or coumadin clinic be able to perform just as well? I'm just asking since I think it's important for the INR to be checked regularly since poor anticoagulation levels can kill.

I hope they have nothing but better results with the advice of the SW dept at their hospital.

 

[ALCapshaw2]

I am fortunate to live in an area that has an OUTSTANDING Anti-Coagulation Clinic that is associated with the main local hospital and Heart Center that serves over 1500 patients. Their 4 CRNP's are well trained and "Know Their Stuff". They see over 100 patients /day.

The Worst Management seems to come from single 'stand alone' providers that are often using Out of Date guidelines or are improperly trained / supervised.

The Best Management seems to be through Home Testing and Dosing which Slowly gaining acceptance in the USA. This is more commonplace in Europe, especially Germany.

'AL Capshaw'

 

[Karlynn]

It's a very unfortunate story. But I also agree that the blame lies with the person who had a long wait resulting in not getting tested and then didn't go back. The long wait at the lab at times was one of my reasons for wanting to home test. And there were times where I did procrastinate some thinking "Geesh - I don't have time to wait for an hour or more today." And I'd maybe go past my test date by a week. But I always knew the it was my responsibility and my life. My guess is that this person knew it was important but thought, as many do, that bad things happen to other people.

 

[KAJ]

It's a very unfortunate story. But I also agree that the blame lies with the person who had a long wait resulting in not getting tested and then didn't go back.

I agree with you Karlynn. There are some also some other issues in this situation as well. There is no way the family can afford to self-check. There is also a language and cultural barrier. All we can do is direct the family to take the steps. The rest is up to them. My poor wife has tried very hard to help them. I just hope they now realize how important it is for them to be their own advocate. He was really fortunate this time. I could go into more but I do not think it woiuld be appropriate.

Karl

 

[dick0236]

My guess is that this person knew it was important but thought, as many do, that bad things happen to other people.

Amen, Karlynn

 

[catwoman]

Karl:

Surely there's a medical advocate in their own cultural group who can explain things to them......

 

[KAJ]

Not sure there is one Marsha but it is certainly worth taking a closer look. My wife has also stressed the point. They respect her so hopefully listen they will listen. It is all very scary. I get very nervous on the rare times I miss one dose.

Karl

 

[COLLEEN S]

Very scary!

 

[Eva]

I forgot to take my warfarin with me when I went out of town for a weekeend!! I freaked out but calmed down as my INR was 3.9 a couple of days before travelling. I checked my INR at home (A home monitor is a blessing) and was relieved to find my INR was not affected. I do not think I can live without my home tester!

 

[catwoman]

I forgot to take my warfarin with me when I went out of town for a weekeend!! I freaked out but calmed down as my INR was 3.9 a couple of days before travelling. I checked my INR at home (A home monitor is a blessing) and was relieved to find my INR was not affected. I do not think I can live without my home tester!

Eva:

I keep extra 7-day pill containers in both my overnight bag and in my rolling carry-on.

A friend who is a pharmacist said that should I ever be w/out my warfarin, I could go to a pharmacy and get just enough warfarin until I get home. Since I wear a Medic-Alert bracelet and Medic-Alert has my dosage on file, a pharmacy could call to verify I am on rat poison.
I know people who have forgotten to pack their BP meds for the weekend and they've been able to get to a pharmacy & get just enough until they get back home.
If I failed to refill my pill container in my purse and was without my extra stash in my luggage, I'd probably go to the nearest Wal-Mart since that's where my Rxes are filled and I'm sure they'd be in a common database for all Wal-Marts.

 

[Jkm7]

Walgreen's, CVS and Rite Aid pharmacies nationally should be able to call up your records in their computer and see the valid Rx on file. That would enable you to get needed meds to hold you over until you get home.

Of course, I realize some folks use mail in prescription refills and I wonder if that would be helpful while traveling.