Don't know what to do with my primary Doc.!!

[archkre]

Yep - you have the legal right to know your test results. I would get my lawyer back to his emailing.

This doctor (and his/her staff) sounds like a real *bleeped*. If your cardio is acting the way you say, I think it is time to replace both.

In the meantime, insist on them giving you your INR so you at least have something to go on.

Please understand that this is potentially dangerous to you.

As a professional that I am , I understand my cardiologist!
She needs to be paid by the HMO for the PT-INR,s, she can't work Pro-bono or free!!.
Are the PCP well trained to deal whith Coumadin dosage?
Coumadin is just anothe medicine for them among hundred!

 

[Nancy]

Well, your cardiologist must be getting paid by some of the insurance companies to do Protimes, otherwise, why would she have a unit on her desk.

Perhaps you could offer to pay her out of pocket until the time you can get your insurance company find someone else for you.

Perhaps, they could be persuaded to reimburse the card. to do it, under the circumstances.

If you get tested once a week or so, it shouldn't be too terribly expensive to pay it out of pocket. You should have someone new in place in a week or so, at the most.

 

[Karlynn]

Regarding Nancy's suggestion -
My ProTime testing costs me less than $8 a test. The most I've paid (through a different company) was $14/test. Pay the cardio out of pocket. Don't know why your insurance company will not pay her, but will pay your PCP.

 

[geebee]

I wasn't implying your cardio should work for free but, if she is a good cardio, she should understand the implications of an unmanaged INR. I would think she might suggest some way for her to manage your INR. Perhaps testing you with her machine at her cost or slightly above?

Since she is your doctor also, I would think she could be held responsible if you have a stroke or bleed due to an improperly managed INR. Why would she not want to participate in making sure you are covered?

 

[Blanche]

Daniel:
Everyone here, most know more about anticoagulation that your PCP, are telling you that your doctor and his "nurse" are commiting malpractice by not providing you with information about your anticoagulation in a timely fashion. They are also telling you that the only one who can save you is you!!! It is just darned awful to have to change doctors, but you must for you are the only one here now who can have a positive impact on your life.

I know you do not want to be scared, but you must look at your reality square in the eye. It is as simple and as threatening as this: If your INR is too high, you could suffer a bleed somewhere in your body. It could be in your brain. If your INR is too low, you could suffer a stroke. My dear one had a stroke. I'll flash past the details, but I will say that since his first stroke (caused by a Coumadin failure, according to 3 drs. INR=1.7) in December 2000, he has not operated a motor vehicle. That represents a loss of independence for him and for his care giver, his wife. Will your wife drive you from Miami to Boco everyday? I hope you have the picture now. It is time to act now.

It is very hard. I'm sure you have a busy, complex life with many important things demanding your attention. Let me suggest, that at this time, there is nothing more important than getting a handle on your anticoagulation. If that means spending some of your own money, please remember that there is nothing more important than you....

Regards,
Blanche

 

[Kathleen]

Primary doctor

Primary doctor

Daniel
Hopefully you have made the decision to get a new primay doctor that will be able to handle your INR's. My thoughts are that your cardiologist needs to handle your labs until you find a new doctor. I had a situation with a new lab that I went to after moving to a new area. The lab would draw the INR and fax the result to my cardiologists nurse practitioner which seems easy in this day in age. The lab was the problem they would never do the faxing without my nurse calling them. I would walk out of the lab and say you will fax that as soon as it is done and they would agree then not do it. I spoke with the doctor on two occasions and she would call the lab and the head of the lab letting them know the liability they would be under if they would not follow through as directed. One time they sat on the results for a week and I was non therapetic during that time. I was in the room as she spoke to the lab but still they would not take the time. I finally had enough and switched to a new clinic and was very firm at my first meeting with that clinic. So far so good so if you can have the draw done where it is the most convenient for you and have them sent to your cardiologist until you can find someone able to handle coumadin.
Home testing hopefully will be in my future. QAS is not a preferred providor for me so I am still working on plan B. If I would win the lottery I would spend it on buying a home test machine for everyone who wanted one...guess I would have to buy a ticket to win though.
Kathy

 

[archkre]

Where can I learn how to manage myself the dosage of Coumadin?

 

[imhayley]

Wishing you well

Wishing you well

All I can say is unbeluckingfeavable! I sure hope this gets straightened out for you Daniel. I know how stressful this must be and so I wish you well. Good luck and sorry I dont have the magic answers.

 

[ALCapshaw2]

WHOA Danial !

Slow down, educate yourself, and find a good Coumadin Clinic.

Does your Cardiologist know how poorly your PCP is managing your INR? If not, tell her, then ask for a referal to either a PCP who knows what he/she is doing OR a Coumadin Clinic that can properly manage your Coumadin.

There is a list of Coumadin Clinics for the entire USA on the AntiCoagulation Forum at www.acforum.org

Click on Clinic Locations, Click on Southeast, Click on Florida and look for one close to you.

The Cleveland Clinic (of Florida) has a Coumadin Clinic in Ft. Lauderdale

Alternatively, get your Cardiologist to write you a prescripton for Home Testing and contact QAS (sponsor of this website) to start the process of obtaining an instrument.

Have you read Al Lodwick's website ?
See www.warfarinfo.com to learn everything you need to know about living with / on Coumadin

Probably the FIRST thing you need to know is that the SAFE RANGE is from an INR of 2.0 to 5.0

An INR below 2.0 can lead to blood clots and/or strokes.
An INR above 5.0 MAY lead to bleeding incidents if maintained at that level for 'some' time.

At 4.5, the usual advice would be to lower your weekly dose by 5 to 10% and retest in ONE WEEK.

OK, take some deep breaths and go back through the above list. Bug your Cardiologist to get you into a new PCP (preferably an Internist) ASAP.

Good Luck,

'AL Capshaw'

 

[archkre]

Have you read Al Lodwick's website ?
See www.warfarinfo.com to learn everything you need to know about living with / on Coumadin
Can you tell me specifically to what part of that site should I go, please?

 

[Blanche]

Daniel:
There's so much to know. Hardly know where to begin. I am going on the assumption that you were having difficulty finding the "meat" of the site, so I will post access to the topics here http://www.warfarinfo.com/warfarinfo.com2.htm
http://www.warfarinfo.com/INR.htm

Once you get there, you may choose as you wish. THere isn't necessarily a beginning or ending. If you have questions, or need more info on a topic, ask here and someone will reply. I have a numbr of articles that I can send if the time comes.

My suggestion to you would be to learn as much as possible from Al's site, then perhaps go in to specific articles on specific topics. Sure hope this helps.

Blanche

 

[warrenr]

complaint

complaint

For whatever it is worth here is the link for filing a complaint against a physician in the state of Florida:

http://www.doh.state.fl.us/mqa/enforcement/frm_general-medUCF.pdf

 

[BDMc]

Malpractrice

Malpractrice

Daniel, Sorry to hear of your troubles! It is a shame that one doesn't seem to have any rights until after damage has been done! I would contact any, and all other docs, and explain the situation to them. Your PCP, and his nurse are both guilty of gross negligence. There is very little one can do to stop bad doctors from continuing their malpractice. They are a self regulating group, and as near as I can tell, being held acountable less and less. Listen to Marguerite and Karlynn! If you have to call your insurer, and go to the ER. Perhaps that will get things moving. Definately report this quack to your insurance company, and anybody else you can! Use Warren's link!

 

[catwoman]

Have you read Al Lodwick's website ?
See www.warfarinfo.com to learn everything you need to know about living with / on Coumadin
Can you tell me specifically to what part of that site should I go, please?

Daniel:
You may want to purchase a booklet about warfarin that Al Lodwick offers at his website. Even though the information is available for free at the website, I chose to purchase the spiral-bound booklet. I keep the booklet with a ring-binder notebook that I add articles about warfarin as needed.

 

[Marty]

Daniel, Keep a record of your interaction with this doctor.Then send the record to the Florida state board. Last month Maryland lifted the license of a doctor for poor coumadin management.Nothing gets a doctors attention like the threat of losing a license. They can usually get it back in a year or so but its an expensive lesson.

 

[BDMc]

Do IT!

Do IT!

Daniel, Marty has a great idea there! Marty, I knew I liked you! Brian

 

[Blanche]

Daniel:
A short time ago you asked about monitoring your own anticoagulation. This article, found on the Cleveland Clinic site, might be helpful to you.

http://www.ccjm.org/pdffiles/Jaffer...=0&order=r&uq=%www.ccjm.org%&cq=&id=4384caff7

I found it in another post by Warrenr today. Thanks Warrenr.

Blanche

 

[archkre]

Wonderful material!
Thanks, that article is very deep, and a little confusing for a poor architect like me!
What if I missed my Coumadin one day?
(What to do is not very clear in the article!)

 

[Blanche]

Daniel:
Many of the articles are written for doctors or medical professionals. But, once you begin to make sense of the terminology, they become easier to understand.

One size does not fit all here when it comes to missing a dose. Albert seldom misses a dose. In past, if he remembers within 6-8 hours, he just takes the usual dose. If more time has lapsed, he just takes his usual dose at the usual time. Other people here have developed different ways to cope with this.

All of this gets back to the fact that you have to become very knowledgeable on anticoagulation in order to make decisions. Knowing how coumadin/warfarin works is crucial in deciding what to do when self-monitoring and making decisions about missed doses. I've been here for nearly 5 years and I still learn something new almost every time I visit.

http://coumadin.usonlinerx.net/faq.html

Blanche

 

[Georgia]

If you miss a dose, your best bet is to take your usual dose and parcel out the amount of the missed dose over a week. That way you'll keep your weekly dosage the same. For instance, if you're taking 5 mg per day, take your usual and add 1 mg for 5 days.

Warfarin is a very slow acting drug that takes around 72 hours to get processed in the liver; so adding the equivalent of the missed dose will help stabilize your inr.